Nocturnal Hypoxemia Burden Correlates With Vestibular Dysfunction in Obstructive Sleep Apnea

IF 1.9 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2026-10-02 Epub Date: 2026-07-15 DOI:10.1111/coa.70146

Dachan Kim, Seong Hoon Bae, Hyung-Ju Cho

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Abstract

Introduction

Obstructive sleep apnea (OSA) is a potential contributor to vestibular dysfunction, though specific correlating parameters remain unclear. This study aimed to determine whether hypoxemia severity indices correlate quantitatively with caloric slow-phase eye velocity (SPV), a marker of vestibular function.

Methods

In a retrospective cohort of 82 adults undergoing both full-night PSG and bithermal caloric testing, the primary outcome was total caloric SPV (°/s; sum of four irrigations). Fifteen prespecified predictors were evaluated, including hypoxemia burden (apnea–hypopnea index [AHI], oxygen desaturation index [ODI], cumulative time with SpO₂ < 90% [CT90], nadir SpO₂), sleep fragmentation (total arousal index), sleep architecture (N1, N2, N3, rapid eye movement [REM] proportions and sleep efficiency) and ancillary measures (snoring index, pulse rate, age, sex and body mass index [BMI]). Unadjusted associations were calculated using Pearson's correlations. For adjusted inference, ordinary least squares with backward Akaike information criterion (AIC) reduction were employed. Feature importance was quantified without prespecifying functional form by training a random-forest regressor and computing TreeSHAP values.

Results

SPV was inversely correlated with AHI (r = −0.295, p = 0.007), ODI (r = −0.261, p = 0.018) and CT90 (r = −0.254, p = 0.021). Sleep efficiency, snoring index, pulse rate, nadir SpO₂, and sleep stage proportions showed no significant associations. In the adjusted linear model, AHI and sex were retained; each 10-event/h AHI increase corresponded to a 3.16°/s lower SPV (95% CI: −6.05 to −0.28; p = 0.032). The random forest model achieved a pooled fivefold R ² of 0.065, indicating low explained variance. Regarding mean absolute SHAP values, hypoxemia-domain metrics ranked highest (ODI, AHI, CT90), followed by BMI, while other features had minimal impact.

Conclusion

Nocturnal hypoxemia burden—reflecting the frequency and cumulative duration of oxygen desaturation—emerged as the principal predictor of reduced caloric SPV in patients with OSA. While the low explained variance of our models (R ² = 0.065) suggests these associations should be viewed as hypothesis-generating, the findings support prioritising desaturation assessment in clinical settings. Further longitudinal research is essential to verify whether reducing hypoxemia leads to improved vestibular outcomes.

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阻塞性睡眠呼吸暂停患者夜间低氧血症负荷与前庭功能障碍相关。

梗阻性睡眠呼吸暂停（OSA）是前庭功能障碍的潜在因素，尽管具体的相关参数尚不清楚。本研究旨在确定低氧血症严重程度指数是否与前庭功能的标志——热量慢相眼速度（SPV）定量相关。方法：在一项回顾性队列研究中，82名成年人接受了通宵PSG和双热热测试，主要结果是总热量SPV（°/s；四次冲洗的总和）。评估了15项预先设定的预测指标，包括低氧血症负担（呼吸暂停-低通气指数[AHI]、氧去饱和指数[ODI]、SpO2累积时间）、睡眠片段化（总唤醒指数）、睡眠结构（N1、N2、N3、快速眼动[REM]比例和睡眠效率）和辅助指标（打鼾指数、脉搏率、年龄、性别和体重指数[BMI]）。未调整的关联使用Pearson相关计算。对于调整后的推理，采用了普通最小二乘和后向赤池信息准则（AIC）约简。通过训练随机森林回归器和计算TreeSHAP值来量化特征重要性，而无需预先指定功能形式。结果：SPV与AHI （r = -0.295, p = 0.007）、ODI （r = -0.261, p = 0.018）、CT90 （r = -0.254, p = 0.021）呈负相关。睡眠效率、打鼾指数、脉搏率、最低SpO2和睡眠阶段比例无显著相关性。在调整后的线性模型中，AHI和性别保持不变；AHI每增加10个事件/小时，SPV降低3.16°/s （95% CI: -6.05 ~ -0.28; p = 0.032）。随机森林模型的合并五倍R2为0.065，表明解释方差较低。关于平均绝对SHAP值，低氧域指标排名最高（ODI， AHI, CT90），其次是BMI，而其他特征影响最小。结论：反映氧去饱和频率和累积时间的夜间低氧血症负荷是OSA患者热量SPV降低的主要预测因素。虽然我们模型的低解释方差（R2 = 0.065）表明这些关联应被视为假设产生，但研究结果支持在临床环境中优先进行去饱和评估。进一步的纵向研究是必要的，以验证是否减少低氧血症导致改善前庭预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.